Abdominal Injury From Bicycle Accident?

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Abdominal Injury From Bicycle Accident?
A 12-year-old riding a bicycle crashed at a construction site and sustained a 2 x 4 punch injury to the left upper quadrant of the abdomen. The patient presented 2 hours later to the emergency department -- pale, semi-responsive, with a blood pressure 125/65-105 mm Hg, and with acute abdomen. An ultrasound showed a left retroperitoneal hematoma and free pelvic fluid. Should a computed tomography (CT) scan be done?

The answer is yes, if the patient is hemodynamically stable. Ultrasound misses approximately 5% of significant operative injuries. Furthermore, the CT of the spleen would show whether there is a blush of contrast, which has a poor prognosis for nonoperative management. Associated injuries to the liver and hollow viscous organs such as the small bowel can also be diagnosed by CT. The latter would clearly require operative management.

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